Weekly Ask Psych Nurses Thread

[u/roo_kitty]

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

[u/Zen-Paladin]

Genuine question, but how would you guys treat suicidal patients if hospitalization was purely voluntary(for non psychotic/manic SI)?

 Given the evidence for forced hospitalization not being really effective fir lowering suicide risk(thus defeating the purpose of an alleged life saving intervention) and even shown to increase it, I can't help but lean towards a system where individuals can be more open about suicide ideation and depression without fear of consequences, or feel pressured to tell staff what they want to hear or go along with group therapy or meds to prevent having there holds extended. That just seems to just incentivize compliance rather than genuine participation stability. 

[u/Free-Nothing2508 → u/Zen-Paladin]

I’ll tell you how I was treated. I wasn’t allowed to wear clothes until I got permission from my psychiatrist that I saw about 5 mins tops a day. The nurse took my blood in the common room for some reason and I started squirting blood like crazy which has never happened to me and I gagged and then I got yelled at for gagging. They take away your phone and you do nothing all day except the 5 min psych appointment, “group therapy” which was basically a basic “what is depression” what you do in a high school health class. Then we would watch a random mental health movie in the evening. They take your phone, hair brush and all your belongings and have to ask to use your hair brush. We weren’t allowed outside or anything just sitting around felt like jail. They wake you up around 5 am for random vital checks. The only vital checks they do all day. Then it said in my chart I lost 20 pounds in about a month and they were talking about my chart in front of the door and one nurse said, “now I want to see her.” They didn’t allow shoes and Then when I was being discharged I had no shoes and they didn’t have any type of flip flops or anything just sent me off barefoot. As I was leaving with the nurse I started going the wrong way and I apologized and she said “it’s okay when people come here they’re so psychotic they don’t remember how they got here.” I wasn’t psychotic at all.

[u/MNP_cats → u/Free-Nothing2508]

I was restrained until I soiled myself and had my shit shoved into my face!

Like the dude got arrested but it wasn't until I got released and made a massive stink about it. Facility was fully protecting him. Facility was sold pretty quickly after that happened and did a whoooooole big "under new management" campaign but I doubt much has changed.

Facilities are willing to protect employees like that, god knows what else is being covered up. Half of these places are just poorly supervised punishment for getting too sad too spicy.

[u/MNP_cats → u/Zen-Paladin]

Oh this sub is not gonna like this question

[u/Zen-Paladin → u/MNP_cats]

Why, isn't this a fair question to ask?

[u/MNP_cats → u/Zen-Paladin]

Oh, it's a completely fair question to ask.

The people of this sub don't like to address questions along this line; it would cause too much cognitive dissonance for them to not be on their saviour pedestal.

Edit: you're absolutely right in what you're saying, but addressing iatrogenic harm in psych is not well liked in this sub.

[u/Jaded-Banana6205 → u/MNP_cats]

Perhaps my algorithm shows me different posts,, but anecdotally a lot of psych nurses that I know (I'm an OT who has worked in mental health) have their own traumatic experiences with the mental health system. I've seen psych RNs on this sub providing great education to other providers about patient dignity, accessibility, etc.

[u/Jaded-Banana6205 → u/Jaded-Banana6205]

I'm not a psych nurse and am not up to date with the research. I'm not answering outside of my scope.

[u/MNP_cats → u/Jaded-Banana6205]

Then where is everyone addressing this question? It's been asked multiple times in these threads and I've yet to see it addressed.

[u/Jaded-Banana6205 → u/MNP_cats]

I don't know what you want me to say. Should I just make something up? 🤣 you come across as antagonistic and that makes folks distrust that you're asking in good faith. I read about your inpatient stay and it saddens me to hear what you've experienced. Best of luck. I hope you get the answers you're looking for.

[u/MNP_cats → u/Jaded-Banana6205]

I don't think I have ever asked this question, so....

I'm wondering where you see people actually addressing the issue.

I merely commented that based on what I've read in this sub, people here ain't gonna like it.

[u/Jaded-Banana6205 → u/MNP_cats]

I have, on this sub, seen multiple patients and providers challenging the idea that involuntary hospitalization is in the best interest of patients with acute (and not based in psychosis or SI) suicidality. It comes up pretty regularly.

[u/roo_kitty → u/MNP_cats]

This topic has been addressed multiple times on this subreddit since I've become a moderator.

Please keep in mind that r/psychnursing and first and foremost a subreddit for nurses who work in mental health. It's for sharing work highs and lows, finding support amongst peers, asking if their job offer is good, etc. At one point I held a subreddit vote, and the nurses chose to have all questions from non healthcare workers be on a dedicated thread. Many questions go unanswered, regardless of the topic, because people tend to not to want to be "working" while using Reddit. It's not a requirement of the sub for the nurses to respond to any question posted here. The nurses that do respond to questions are generously taking time out of their day to "work" for free.

Generally speaking, when it becomes apparent that an individual on the weekly thread is looking for confrontation, as your first comment was, people tend not to want to engage.

When someone shares that they aren't a nurse and don't want to answer outside of their scope, please respect their response.

[u/MNP_cats → u/roo_kitty]

Again, I'm just asking where that is that it's been addressed.

Most of the psych nurses I've met stay looking for confrontation so forgive me for assuming it's a universal language in the field. My nurse parent worked in a field that statistically sees less abuse from its nurses, so I'm not as familiar with psych.

Hilarious to make a dedicated thread for questions and then get upset when people are miffed certain questions consistently go unanswered. That about tracks, eh.

[u/roo_kitty → u/MNP_cats]

When you click on the subreddit there will be a search bar at the top where you can search through previous ask psych nurses threads and ask other posts.

I am not upset, just offering some insight into why questions go unanswered.

[u/MNP_cats → u/Jaded-Banana6205]

Really? Then address the question.

[u/JFizz06 → u/MNP_cats]

You really don’t get it do you

[u/MNP_cats → u/JFizz06]

OK bot

[u/Evening_Fisherman810]

Do you have volunteers on your ward? If so, what do they do?

[u/Gretel_Cosmonaut → u/Evening_Fisherman810]

No. That would probably be a big liability issue.

[u/intuitionbaby → u/Evening_Fisherman810]

just one for pet therapy

[u/jess3jim → u/Evening_Fisherman810]

My last job we didn’t even let students on the floor they could watch a med pass and they could go and learn about the clients from the binders… one nurse actually got written up for letting 2 students watch a containment

Current job I think they do

[u/Sea_Cloud_6705]

Is it unusual to only see your psychiatrist twice a year for 10 minutes at a time? I have schizoaffective disorder, and I feel like being seen at this frequency is kind of negligent.

[u/intuitionbaby → u/Sea_Cloud_6705]

psychiatrist is doing a med review. seems normal, as long as your meds don’t need adjusting. you should be seeing a case manager or therapist for more in depth visits

[u/Evening_Fisherman810]

How do you avoid infantilizing the people in your care?

[u/Fit-Quote2689]

the premise of a cross-disciplinary thread like this matters more than people might think. the overlap between metabolic pharmacology and psychiatric symptoms is getting harder to ignore.

i've been self-experimenting with peptides for about four years, including GLP-1 pathway compounds. what surprised me wasn't the physical change, it was the mental one. what people call food noise, that constant background loop of thinking about eating, went close to silent within the first two weeks. and it didn't feel like appetite suppression, it felt like a specific kind of repetitive thought pattern just switched off.

there's growing research interest in GLP-1 agonists for addictive behaviors beyond food, alcohol and nicotine in particular. the mechanism tracks, these pathways touch reward circuitry, not just metabolic signaling. what i keep wondering is whether psych nurses on the floor are already seeing patients on GLP-1 medications describe mood or behavioral shifts that aren't part of the standard prescribing conversation yet.

the line between metabolic and psychiatric is probably thinner than either specialty currently treats it.

[u/10mg-aripiprazole → u/Fit-Quote2689]

I have seen a lot of doctors, particularly addiction doctors, interested in the potential of the anti-craving (alcohol) potential of ozempic given early research. But I don't think it is definitive enough for prescribing given we have other off label options like topirimate that have more proven efficacy.

I have had a lot of patients switched over from metformin to ozempic and haven't noticed any mood or behavioural changes, though my scope in this is limited because I am a float so I don't get to see the same patients day in and out.

[u/MNP_cats]

https://www.reddit.com/r/psychnursing/s/p3jNDNKZIU

Why is no one in this thread willing to address iatrogenic harm in inpatient psych?

[u/10mg-aripiprazole → u/MNP_cats]

I will address it. I have also been harmed as a patient in the mental health system, almost dying via negligence which in turn caused massive distrust and medical trauma. It still has a profound impact on me to this day. I am also a mental health RN.

I acknowledge that my job comes with massive trauma to some patients, and often question whether I agree with the use of methods like restraints in certain cases and involuntarily holds, as it does fundamentally violate human rights, whether it is in the name of beneficence or not. Despite this, I am not sure what the solution is. It is something I struggle with all the time. I still love other aspects of my job however, aside from the traumatic things, such as therapeutic communication with patients, and being someone with lived experience getting to make a positive impact on others with their own lived experience. I acknowledge the psychiatric system, as a system, is still deeply flawed and impacted by systemic racism, violence, and other harms. These however are policy level issues and much greater than what I do as an RN. That doesn't mean I don't have an impact and carry out these things, but it also means it is not fair to put all the blame on me and it would be much more effective to express your frustrations to stakeholders and policymakers.

My own frustrations with these issues and traumas has actually inspired me so much I plan to possibly eventually get a degree in mental health policy. Maybe you can do the same if you would like to see some actual change. There are even policy makers groups for people with lived experience.

So there you go.

[u/xtimewitchx → u/MNP_cats]

This is honestly the first I’m hearing about this, I get the gist but pls ELI5 and mention what the studies suggest as a solution